Healthcare Provider Details

I. General information

NPI: 1295042984
Provider Name (Legal Business Name): MARI PAT ROSE RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARI PAT RETHWISCH RN

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 SAINT ANDREW ST STE 100
LA CROSSE WI
54603-2378
US

IV. Provider business mailing address

817 GEORGE ST
LA CROSSE WI
54603-2673
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-6266
  • Fax: 608-785-6315
Mailing address:
  • Phone: 608-519-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number167141-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: